Lipomatous Hypertrophy of the Atrial Septum
Contrast-enhanced computed tomography of the chest (of which two axial sections are shown here) was carried out to investigate the cause of exertional dyspnea in a 77-year-old man. Signs of chronic obstructive pulmonary disease (COPD) were accompanied by a barbell-shaped mass with the density of fat arising from the atrial septum (straight arrows). The fossa ovalis was unaffected (arrowhead), the superior vena cava significantly constricted (curved arrow). Lipomatous hypertrophy of the atrial septum (LHAS) was diagnosed on the basis of the typical morphology and location. LHAS is a benign hyperplasia of lipocytes in the atrial septum (more exactly, in the fold of the septum secundum). The fossa ovalis forms part of the septum primum and thus remains unaffected, producing the typical barbell appearance. Positron Emission Tomography can be pathologic, because brown fat is involved to a varying extent. LHAS is usually asymptomatic. Surgery is indicated only if the mass is hemodynamically relevant or there is severe dysrhythmia. In our patient the symptoms could be attributed to an exacerbation of COPD and there were no signs of superior vena cava syndrome or collateral circulation, so resection was not indicated.
Prof. Dr. med. Okka W. Hamer, Klinik Donaustauf, Uniklinik Regensburg, firstname.lastname@example.org
Conflict of interest statement: The author declares that no conflict of interest exists.
Translated from the original German by David Roseveare.
Cite this as: Hamer O: Lipomatous hypertrophy of the atrial septum. Dtsch Arztebl Int 2022; 119: 187. DOI: 10.3238/arztebl.m2022.0011a